Fee Assistance Application Form (K-W Water Polo)

Fee Assistance Application Form

KW Water Polo Club
FEE ASSISTANCE APPLICATION

Athlete's Basic Information

Athlete's First Name^*

Required

Athlete's Last Name^*

Required

Athlete's Gender Identity^*

Required

Athlete's Date of Birth^*

Required

Primary Email Contact^*

Required

Email address monitored most frequently for this Athlete - Example: [email protected]. A copy of your membership application will be sent to this address.

Athlete's Contact Information

Athlete's Street Address^*

Required

Athlete's City^*

Required

Athlete's Postal Code^*

Required

Athlete's Home Phone^*

Required

Example: ###-###-####

Parent/Guardian Contact Information

First Parent/Guardian Full Name^*

Required

First Parent/Guardian Relationship To Athlete^*

Required

First Parent/Guardian Phone Number^*

Required

Example: ###-###-####

First Parent/Guardian Email Address^*

Required

Example: [email protected]

Second Parent/Guardian Full Name

Second Parent/Guardian Relationship To Athlete

Second Parent/Guardian Phone Number

Example: ###-###-####

Second Parent/Guardian Email Address

Example: [email protected]

Third Parent/Guardian Full Name

Third Parent/Guardian Relationship To Athlete

Third Parent/Guardian Phone Number

Example: ###-###-####

Third Parent/Guardian Email Address

Example: [email protected]

Fourth Parent/Guardian Full Name

Fourth Parent/Guardian Relationship To Athlete

Fourth Parent/Guardian Phone Number

Example: ###-###-####

Fourth Parent/Guardian Email Address

Example: [email protected]

Family Information

Please Select the Size of Your Family Unit^*

Required

Please Select Your Total Family Unit Income (before tax):^*

Required

Number of Income-earning Members in the Family Unit:^*

Required

Financial Information

KW Water Polo aims to provide assistance to athletes from families in need of financial assistance. In order for us to determine "Financial need" we require any one of the following for each income-earning member of the family unit: - Notice of Assessment - Prior year T4 - Prior year T1

You have the option of attaching a scan or a picture of the documents indicated above and upload.

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.

Certification

I certify that the information entered above and the documents I have uploaded or will share in hardcopy reflect all the income earning members in the family unit as indicated above.^*

Fee Assistance Application Form (K-W Water Polo)

Athlete's Basic Information

Athlete's Contact Information

Parent/Guardian Contact Information

Family Information

Financial Information

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